Case: Geriatric Patient
History:
A mixed breed retriever type, female, 15 years old, was presented with a complaint of unable to rise, developing cataracts, poor hair coat, and difficult defecation.
Physical Examination:
- Trouble rising, partially due to the hips and partially due to mild paresis
- Dry, dull coat, mildly obese
- Developing mild posterior cataracts in both eyes
- The dog has hard stools and tends to fall down when defecating
Blood Test Results:
- T4 (thyroid): low normal
- SGPT: mild elevated
Therapeutic plan:
- Active Bovine Glandular Thyroid, 4 grains twice daily
- Glucosamine sulfate, 500 mg twice daily
- DL Phenylalanine, 500 mg twice daily
- Dimethylglycine, 100 mg twice daily
Results:
Over the course of two months, the coat dramatically improved, weight was reduced 10%, and dog seemed much more energetic
The cataracts stopped progressing
The dog started to sleep normally at night
She was able to climb stairs and play again
The owners reported her to be more active than in last 2 years
Rationale
Glucosamine
Sulfate
In some ways, considered to be the Gold Standard of nutraceutical supplements for arthritis
Why:
Glycosaminoglycan (GAG) are chemically similar to the mucopolysaccharides of cartilaginous tissue, hyaluronic acid
There are a number of different GAGs in the body, including:
- chondroitin-4-sulfate
- dermatan sulfate
- chondroitin-6-sulfate
- heparin & heparin sulfate
- keratan sulfate
- hyaluronic acid
- proteoglan
For formation of joint fluids, there must be the the precursor GAG's available, including:
- Glucosamine sulfate
- Glucosamine HCl
- N-acetyl-D-glucosamine
All are formed from D-glucose; the rate-limiting step (most important step) is the conversion of D-glucose to D-glucosamine
Why Glucosamine sulfate works so well:
- Active uptake through intestine
- Sulfur group supports the formation of Gags
- Decrease the pain of arthritis
- Improve joint function
Consider Glucosamine Sulfate for:
- Degenerative joint disease
- Inflammatory bowel disease
- Chronic colitis
(N-acetyl-D-Glucosamine maybe best-supports glycoprotein-mucous membrane
of gut lining)1
1.Burton AF, et al Decreased incorporation of 14C-glucosamine relative to 3H-N-acetyl glucosamine in the intestinal mucosa of patients with inflammatory bowel disease. Am J Gastroenterol.;78(1):19-22, Jan 1983.
- Disc disease
- Food allergies (see #3, colitis)
Glandular Thyroid
- Bovine thyroid with active thyroid hormone was used
- Thyroid glandulars may provide nutrients needed by the thyroid gland
- May provide "oral tolerance" thus sparing the thyroid gland
- Will provide a low but significant dose of thyroxine
- Less negative feedback inhibition of thyroid gland
- Smaller fluctuations in T-4 throughout the day
There are a number of thyroid glandular products on the market, some with active thyroid hormone and some without. If the dog is receiving levothyroxine (synthetic thyroid, Synthroid, Soloxine), only glandulars with no active thyroid should be used.
Dimethylglycine (DMG, N,N-Dimethyglycine)
- The dimethylated derivative of glycine
- An intermediary metabolite in cell metabolism
- Transmethylation
- Methyl groups are moved from one molecule to another
- DMG is required for this process
- Vitamins, hormones, neurotransmiters, enzymes, antibodies, and nucleic acids all require transmethylation
DMG is:
- Synthesized in the body
- Thus, not a vitamin
- Still, there are indications that supplementation can increase the health of cells and be beneficial in a wide variety of disease processes
- DMG readily crosses the blood brain barrier
- Increase methyl group transfer with neurons, thus improving brain function
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DMG and Immune Function
- Increases cellular energy
- Enhances oxygen utilization
- Boosts antibody production and cellular immunity 1
- Enhances many other biochemical transmethylation processes, including detoxification
All of these improves
immune function
1.Reap EA, Lawson JW. Stimulation of the immune response by dimethylglycine, a nontoxic metabolite. J Lab Clin Med, 115(4):481-6, Apr 1990 .
Other Uses for DMG
- DMG seems to decrease cataracts1, perhaps due to improved blood oxygenation
- Said to improve epilepsy although studies have not always shown this2
- Heart disease
- Degenerative
Joint Disease3
1. Todd GP. Nutrition, Health and Disease. Norfolk, Virginia, The Donning Company, 1985.
2. Haidukewych D, et al. N,N-dimethylglycine shows no anticonvulsant potential. Ann Neurol. , 15(4):405, APR 1984.
3.Kendall R. Lawson J. Treatment of arthritis and inflammation using N,N-Dimethylglycine. US Patent 5,026,728, 1994.
dl-Phenylalanine (DLPA)
- Essential amino acid
- Neurotransmitters
- Improves nerve conduction
- Enhances mental focus
- Decreases pain
- Seems to increase the effects of acupuncture
- Especially when the problem is associated with the musculoskeletal system
- Supplemented as the synthetic dl-phenylalanine, simply called DLPA
- Produces tyrosine
- Thyroxine
- Stimulates the production of epinephrine
- Norephinephrine (which in turn produces neurotransmitters)
- Inhibits the decarboxylation of opioids, thus enhancing endorphins
- Used with caution with those taking MOA inhibitors
- Excessive levels will produce anxiety and hypertension
- Dose range is 3-10 mg/kg
DLPA
- Tryptophan & phenylalanine govern the release of an intestinal hormone
- Cholecystokinin (CCK)
- CCK signals the brain to feel satisfied after eating, and decrease food intake
- L-phenylalanine
- Nutritional value
- D-phenylalanine
- Painkilling and depression
- Phenylalanine
- Enhanced by additional Vitamin B 6-especially in studies on depression.
Geriatric Patients:
Should be evaluated for any functional problems associated with any organ or hormonal system.
Some general therapies for aging include therapy for specific problems, such as the ones discussed above. Other therapies that you might consider using include the following:
Phosphatidylserine
- Improves memory
- Aids in well being
- Regulates cortisone
- See Iso-Phos for more information
Dihydroepandosterone
- Hormonal precursor for steroid hormones
L-Deprenyl (Selegiline, Anapril)
- MOA-B inhibitor (dopamine, epinephrine, norepinephrine)
- l-amphetamine
- l-methamphetamine
Lecithin
- Choline-acetylcholine
- Lipotrophic agent
- Phosphatydylcholine
- Phospholipid (membranes)
- Protects and restores intestinal permeability
- Essential for liver function
B-complex vitamins
- As aging progresses, more tissues need regeneration and B vitamins are needed
Pregnenolone
- Neuroactive steroid
- Regulate gene expression
- Memory enhancing
- Sense of well being
- Glucusamine sulfate
- Chondroprotectant (helps joints)
- Mucopolysaccharides enhanced
Antioxidants
High quality proteins
- Lactalbumins click to see more information
Omega 3 oils-Fish oils
- EPA/DHA click to see more information